Direct-to-Implant Retropectoral Dual Plane Approach With Autologous Inferior-Based Dermal Flap: Does SPY-Elite Laser Angiographic System Reduce Complication Rates?

PURPOSE: The study aims to investigate the complications and long-term outcomes associated with retropectoral DTI breast reconstruction with IDF utilizing the SPY-Elite laser angiographic system. MATERIAL AND METHOD: This retrospective study was conducted from June 2017 to January 2023. We examined 52 patients (85 breasts) treated with a direct-to-implant retropectoral dual plane approach with IDF implant coverage. Informed consent was duly obtained from every participant. Inclusion criteria dictated that patients should have medium to large breasts and a second or third degree of ptosis, as per the Regnault ptosis scale. During the intraoperative evaluation, the mastectomy flaps and IDF were assessed with the SPY-Elite laser angiographic system using near-infrared imaging. We recorded patient demographics, characteristic data, and complications. RESULTS: A total of 52 patients, aged 27 to 63, underwent 85 mastectomies using a direct-to-implant retropectoral approach with inferior dermal flap. The average age of the patients was 48, and their average body mass index was 30.8, with a range of 28 to 43. The distance from the nipple to the inframammary fold varied between 14 and 24 cm. The implants used had an average size of 275 cc, ranging from 250 to 650 cc. Textured anatomic implants with either moderate plus or high profile were used in all cases. The sternal notch to nipple distance for these patients ranged from 24 to 38 cm. During the evaluation using the SPY-Elite laser angiographic system, insufficient distal marginal perfusion was detected in five out of 85 inferior dermal flaps, measuring between 2 and 5 cm2. These areas were subsequently debrided, and the reconstructions were successfully completed, representing 5.8% of cases. No instances of necrosis related to IDF have been observed. There have been no failed assessments conducted by SPY ICG. In total, the complication rate was 15.2%, with minor complications occurring in 8.2% of the breasts (7 out of 85) and major ones in 7% (6 out of 85). The subjects were monitored for an average of 14 months, the duration ranging from 12 to 24 months. CONCLUSION: Inferior dermal flaps have considerable advantages, such as a natural autologous blood supply, a more realistic tissue thickness and texture, lower costs, and better tolerance to post-reconstruction radiation. Moreover, using the IDF technique and assessing the perfusion of IDF and mastectomy flaps through the SPY-Elite laser angiographic system appears to be a dependable, efficient way to achieve good cosmetic results in one operation, eliminating the need for additional surgeries. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266.

Round Autoprosthesis: Use of Adipodermaglandular Flap in T Scar Mastopexy.

PURPOSE: This study focuses on the use of round or anatomically shaped breast autoprosthesis with different volumes prepared from the central and lower poles of the breast. The technical details and surgical outcomes for patients with varying degrees of breast ptosis are discussed. MATERIAL AND METHOD: This study involved 42 patients who underwent the Wise-pattern superior pedicle mastopexy procedure using the adipodermaglandular island flap technique. The research spanned from December 2017 to August 2022. The study participants had not previously undergone breast surgery, did not desire breast implants, and exhibited grade 2 and 3 breast ptosis according to the Regnault Classification. Age and preoperative breast measurements of the patients were recorded for subsequent analysis. Measurements, such as the distance from the nipple-areolar complex to the inframammary fold and the distance from the suprasternal notch to the nipple-areolar complex, were taken both before the surgery and one year after. A systematic process was followed to identify acute and subacute complications during the postoperative follow-up period. RESULTS: This study involved 42 patients with a mean age of 33.9 years (range: 23-49 years). These procedures were conducted between December 2017 and August 2022. The average SN-N distance before surgery measured 26.7 cm (range: 24-33 cm). One year after surgery, the average SN-N distance was 23.1 cm (range: 21.3-24.8 cm). The follow-up duration for the examined cases ranged from 12 to 18 months on average. Among the observed cases, delayed wound healing was noted in one instance, venous insufficiency of the nipple in another, and fat necrosis in a third case. The overall complication rate in the group was determined to be 7.1%. CONCLUSION: In our study, the detachment of dermal connections at the level of the inframammary fold (IMF) and the smooth advancement of the flap in the form of an "island flap" made a contribution to upper pole fullness. Furthermore, we hypothesize that the fusion of the medial and lateral ends of the flap will enhance tissue integration during the healing process, promoting compatibility between the autoprosthesis tissue and breast tissue. Regarding the rates of complications described, classic mastopexy techniques have exhibited similar rates in our findings. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparative Analysis of Lower Island Flap Transposition (LIFT) in Wise-Pattern Mastopexy: Does It Improve Upper Pole Fullness and Breast Harmony?

BACKGROUND: Utilization of autologous parenchymal flaps aims to attain enduringly favourable outcomes and uphold volume in the upper breast pole after mastopexy procedures. The objective of this study was to juxtapose and scrutinize postoperative upper pole fullness, upper/lower pole ratios, occurrences of bottoming-out deformity, and complication rates between two patient cohorts: those who underwent the wise-pattern superior pedicle mastopexy with the LIFT technique and those who underwent the conventional wise-pattern superior pedicle mastopexy. MATERIALS AND METHODS: All the patients in this study were appropriately categorized as primary patients, signifying their lack of any prior breast surgery history. These individuals presented with grades II and III breast ptosis on both breasts, ranging from moderate to severe deformities per the Regnault classification. Importantly, all patients uniformly expressed their desire to achieve a firmer breast appearance without recourse to using breast implants. The patients' ages and preoperative breast measurements were recorded for analysis. Measurements, including the distance from the NAC to the inframammary fold and from the sternal notch to the NAC, were systematically measured both before the surgery and at the 1-year postoperative mark. RESULTS: The upper and lower pole ratios, defined by Mallucci and Branford, were found to be 45.22% ± 2.20% and 54.88% ± 2.20%, respectively, within the LIFT group. In 13 instances, a lower pole distance exceeding 55% indicated a potential bottoming-out deformity (value lower than 45%/55% ratio or 0.818). Conversely, within the control group, the upper and lower pole ratios were determined as 43.22% ± 2.80% and 56.88% ± 2.80%, respectively. These findings demonstrated statistical significance. Notably, in 39 cases within the superior pedicle wise-pattern mastopexy group, a lower pole distance surpassing 55% (value lower than 45%/55% ratio or 0.818) suggested a leaning towards a bottoming-out deformity (p: 0.003). A postoperative period of at least 12 months was essential to discern the emergence of upper pole fullness and the potential development of bottoming-out deformities. Among the cases within the LIFT group, 93% exhibited successful attainment of upper pole fullness, while in the control group, this outcome was achieved in 82% of cases (p>0.05). CONCLUSION: Implementing the LIFT technique alongside the wise-pattern superior pedicle mastopexy decreases the occurrence of bottoming-out deformity after 1 year. Although there is no statistically significant difference, the LIFT flap technique has contributed to some extent to upper pole fullness. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Wise-Pattern Superomedial Dermoglandular Pedicle Technique: Improves Breast Upper Pole Fullness and Breast Proportions.

Background: This study aimed to analyze postoperative upper pole fullness, upper/lower pole ratios, bottoming-out deformity, and complication rates for patients who underwent planned bilateral reduction mammoplasty for gigantomastia using the superomedial dermoglandular pedicle technique and Wise-pattern skin excision. Methods: A total of 105 consecutive patients were evaluated postoperatively within a year in full lateral position, and the upper pole was between the lines drawn horizontally from the nipple meridian, where the breast became evident on the chest wall. Flat and slightly convex upper pole slopes were considered well-rounded; the concave ones were evaluated as exhibiting decreased fullness. The lower pole was the height between the horizontal line passing through the level of the inframammary fold and nipple meridian. Bottoming-out deformity was evaluated according to the 45/55% ratio developed by Mallucci and Branford, where the bottom pole was above 55%, at which it was held to be leaning toward bottoming-out deformity. Results: The upper and lower pole ratios were 44.79% ± 2.80% and 55.21% ± 2.80%, respectively. In 4 cases, a lower pole distance of >55% was leaning toward bottoming-out deformity. A minimum of 12 months was required after surgery to detect upper pole fullness and any possible bottoming-out deformity. The upper pole fullness was achieved in 94% of cases that underwent superomedial dermoglandular pedicle Wise-pattern breast reduction. Conclusion: The use of the superomedial dermoglandular pedicle technique with the Wise-pattern in breast reduction operations helps in ensuring upper pole fullness, resulting in less bottoming-out deformity and requiring less revision.

Historique: La présente étude vise à analyser le volume du pôle supérieur, le ratio entre les pôles supérieur et inférieur, les malformations en creux et le taux de complications chez les patientes qui ont subi la mammoplastie de réduction bilatérale planifiée d'une gigantomastie au moyen de la technique à pédicule dermoglandulaire supéro-interne et de l'excision cutanée selon le modèle de Wise. Méthodologie: Au total, 105 patientes consécutives ont été soumises à une évaluation postopératoire en position latérale complète dans l'année suivant l'intervention, et le pôle supérieur se situait entre les lignes dessinées dans un plan horizontal à partir du méridien des mamelons, où la poitrine devenait évidente sur la paroi thoracique. Une inclinaison plate et légèrement convexe du pôle supérieur était considérée comme bien ronde. Une inclinaison concave était plutôt perçue comme présentant un volume réduit. Le pôle inférieur correspondait à la hauteur entre la ligne horizontale passant au niveau du pli inframammaire jusqu'au méridien des mamelons. Une anomalie en creux était évaluée en fonction du ratio 45 %-55 % établi par Mallucci et Branford, où un pôle inférieur supérieur à 55 % était considéré comme une tendance vers une malformation en creux. Résultats: Le ratio entre le pôle supérieur et inférieur s'élevait à 44,79 % ± 2,80 et 55,21 ± 2,80 %, respectivement. Dans les quatre cas, une distance du pôle inférieur supérieure à 55 % démontrait une tendance vers une malformation en creux. Il fallait au moins 12 mois après l'opération pour établir le volume du pôle supérieur et toute anomalie en creux. Le volume du pôle supérieur était satisfaisant dans 94 % des cas soumis à une réduction mammaire au moyen de la technique à pédicule dermoglandulaire supéro-interne et de l'excision cutanée selon le modèle de Wise. Conclusion: L'utilisation de la technique à pédicule dermoglandulaire supéro-interne selon le modèle de Wise lors des opérations de réduction mammaire contribue à assurer le volume satisfaisant du pôle supérieur, lié à moins de malformations en creux et moins de révisions chirurgicales.

The Effect of Locally Delivered Apocynin on Fat Graft Survival in an Experimental Rat Animal Model.

We aimed to investigate the efficacy of locally delivered apocynin on fat graft survival in an experimental autologous fat grafting (AFG) model created in rats. Twenty-one Wistar albino male rats were included in this study. The 0.647 g mean weight grafts were harvested from the inguinal region and transferred to the nape of every rat. The subjects were randomly separated into three groups. Saline, dimethyl sulfoxide (DMSO), and apocynin, a dose of 20 mg/kg, solutions were applied once a day for 2 weeks. After 3 months, the rats were sacrificed. The evaluation of physical measurements (weight and volume) and survival rates of the grafts for volume and weight, the viable cell count (VC) with the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, and histopathological parameters were done. All biophysical parameters were found to be significantly higher in the apocynin group compared with other groups (p < 0.05). In the MTT test, the saline group was normalized to 100%. According to this, DMSO and apocynin groups' means were 106 and 163%, respectively. The VC was significantly higher in the apocynin group than the other groups (p < 0.05). The VC was significantly higher in the DMSO group than in the saline group (p < 0.05). No significant difference was found in other comparisons performed according to biophysical and histopathological parameters (p > 0.05). The locally delivered apocynin decreases fat graft volume loss in an experimental AFG model. Consequently, apocynin can be used as an effective substance to increase graft survival. The level of evidence was not available.

Use of honey as an adjunct in the healing of split-thickness skin graft donor site.

BACKGROUND: Different techniques are being used in treatment of split-thickness skin graft donor sites; however, there is not a widely accepted method established for these partial-thickness wounds. It is well known that honey has been very effective in the treatment of various types of wounds, but there is not any information about the usage of honey as split-thickness skin graft donor site dressing in the literature. OBJECTIVE: To evaluate and compare the effectiveness of honey-impregnated gauzes, hydrocolloid dressings, and as a conventional dressing, saline-soaked gauzes for skin graft donor sites. METHODS: This is a nonrandomized, prospective, open-label (noncontrolled), side-by-side comparison trial of various options that are available for second-intention healing of donor site for split-thickness skin grafts. Eighty-eight patients who underwent skin grafting were observed using two different groups. In the first group, the donor site was divided into two equal halves, with each half being treated with honey-soaked gauzes and the other half with paraffin gauzes (group 1A), hydrocolloid dressings (group 1B), and saline-soaked gauzes (group 1C) alternatively. In the second group, two separate donor sites were formed, with one of them being treated with honey-impregnated gauzes (groups 2A-C) and the other one treated with either paraffin gauzes (group 2A), hydrocolloid dressings (group 2B), or saline-soaked gauzes (group 2C). The healing time, rate of infection, and sense of pain were evaluated. RESULTS. : In the treatment of split-thickness skin graft donor sites, honey-impregnated gauzes showed faster epithelization time and a low sense of pain than paraffin gauzes and saline-soaked gauzes. There was no significant difference between honey-impregnated gauzes and hydrocolloid dressings with regard to epithelization time and sense of pain. CONCLUSION: The use of honey-impregnated gauzes is effective, safe, and practical. Honey can be an alternative material for the split-thickness skin graft donor site treatment.